Magbro Healthcare Private Limited

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Your safety is our priority. Please complete this form to report any adverse event or unexpected reaction associated with our product. The information provided will help us evaluate the incident and ensure the continued safety and quality of our products.

    Adverse Event Reporting Form

    Patient Information






    Product Information








    Adverse Event Details







    Patient Medical History


    Concomitant Medications (if any)


    Declaration

    I confirm that the information provided above is true and accurate to the best of my knowledge.